A1 Refereed original research article in a scientific journal
A Selective Biomarker Panel Increases the Reproducibility and the Accuracy in Endometrial Biopsy Diagnosis
Authors: Nastic D, Shanwell E, Wallin KL, Valla M, Masback A, Mateoiu C, Lidang M, Liakka A, Lappi-Blanco E, Grove A, Davidson B, Carpen O, Bertelsen BI, Bak J, Abusland AB, Selling J, Carlson JW, Carlson JW
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Publication year: 2017
Journal: International Journal of Gynecologic Pathology
Journal name in source: INTERNATIONAL JOURNAL OF GYNECOLOGICAL PATHOLOGY
Journal acronym: INT J GYNECOL PATHOL
Volume: 36
Issue: 4
First page : 339
Last page: 347
Number of pages: 9
ISSN: 0277-1691
eISSN: 1538-7151
DOI: https://doi.org/10.1097/PGP.0000000000000334
Abstract
Grading and histologic typing of endometrial cancer in biopsy material has a direct impact on the decision to perform lymphadenectomy and/or omentectomy in many cancer centers. Endometrial biopsies are among the most common general surgical pathology specimens. Multiple studies have shown that biopsy diagnosis suffers from a lack of reproducibility. Although many biomarkers have been proposed, none have been demonstrated to improve the diagnosis in the biopsy setting. In this study, 70 biopsies with endometrial carcinoma were supplemented with a biomarker panel consisting of ER, PR, P53, and DNA ploidy. A representative H&E slide was scanned digitally and made available to 12 gynecologic pathologists in 4 Nordic countries: Finland, Denmark, Sweden, and Norway. Reviewers diagnosed the cases both before and after being provided with the biomarker results. The interobserver percent agreement and Cohen kappa improved from 75.8% (kappa = 0.52, moderate) to 84% (kappa = 0.68, substantial) with inclusion of the biomarker panel. Agreement with the subsequent hysterectomy diagnosis also improved from 83.6% (kappa = 0.67) to 88.7% (kappa = 0.77). There was no statistical improvement between a reflex (84% agreement) and a reflective testing algorithm (82.9% agreement), suggesting that the selective use of biomarkers is appropriate. Difficult cases were almost exclusively high-grade tumors. Finally, a statistical model indicated that only P53 and DNA ploidy, in conjunction with an H&E review, had an impact on the decision to upgrade or downgrade cases.
Grading and histologic typing of endometrial cancer in biopsy material has a direct impact on the decision to perform lymphadenectomy and/or omentectomy in many cancer centers. Endometrial biopsies are among the most common general surgical pathology specimens. Multiple studies have shown that biopsy diagnosis suffers from a lack of reproducibility. Although many biomarkers have been proposed, none have been demonstrated to improve the diagnosis in the biopsy setting. In this study, 70 biopsies with endometrial carcinoma were supplemented with a biomarker panel consisting of ER, PR, P53, and DNA ploidy. A representative H&E slide was scanned digitally and made available to 12 gynecologic pathologists in 4 Nordic countries: Finland, Denmark, Sweden, and Norway. Reviewers diagnosed the cases both before and after being provided with the biomarker results. The interobserver percent agreement and Cohen kappa improved from 75.8% (kappa = 0.52, moderate) to 84% (kappa = 0.68, substantial) with inclusion of the biomarker panel. Agreement with the subsequent hysterectomy diagnosis also improved from 83.6% (kappa = 0.67) to 88.7% (kappa = 0.77). There was no statistical improvement between a reflex (84% agreement) and a reflective testing algorithm (82.9% agreement), suggesting that the selective use of biomarkers is appropriate. Difficult cases were almost exclusively high-grade tumors. Finally, a statistical model indicated that only P53 and DNA ploidy, in conjunction with an H&E review, had an impact on the decision to upgrade or downgrade cases.
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